Medical exigencies are unpredictable and can cause a vicious financial crisis in someone’s life. The current pandemic of COVID-19 has shown us the importance of a good health insurance plan. Besides COVID-19, the rising cost of medical treatments, medicines and the overall cost of hospitalisation can be stressful for anybody.
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Therefore, getting a health insurance policy for you and your family can provide cover in times of uncertain needs. To beat the medical treatment inflation, the Insurance Regulatory and Development Authority of India (IRDAI) comes with a standard health insurance coverage known as the Arogya Sanjeevani health insurance policy to provide the insurance benefits at an affordable premium.
What is the Arogya Sanjeevani health insurance policy?
Arogya Sanjeevani is a standard health insurance product by the Insurance Regulatory and Development Authority of India (IRDAI) from April 01, 2020. It provides coverage against medical expenses up to 5 lakhs. According to IRDAI, the Arogya Sanjeevani Policy aims to mandate all insurers to provide standard and basic health insurance plans for individuals and families.
All health insurance companies offer the Arogya Sanjeevani health insurance policy. The only difference is the plan’s premium, and their service and settlement process can vary according to the different insurance companies and their company norms. Arogya Sanjeevani health insurance offers two different types of plans;
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- Individual plan: As the name suggests, it is only for one person as a policyholder.
- Family floater plan: In the family floater plan, you can add your spouse, children, parents and in-laws against the single premium.
Features of Arogya Sanjeevani health insurance
Various specific features set Arogya Sanjeevani’s health insurance apart from other health insurance policies in India. Some of the vital features are listed below;
- Affordable policy: Compared to other health insurance policies, Arogya Sanjeevani is affordable with the same coverage. It offers both individuals as well as family floater plans.
- Cumulative bonus: In the Arogya Sanjeevani health insurance policy, the policyholder gets a 5% bonus on the sum insured for each claim-free year. The no claim bonus can take place cumulative and go up to 50%.
- Sum insured options: Arogya Sanjeevani health insurance let you choose from a sum insured range of 1 lakh to 5 lakhs.
- Waiting period: Except for an accident, the plan has a waiting period of 30 days for all illnesses and diseases.
- COVID hospitalisation: Arogya Sanjeevani offers hospitalisation expenses cover for COVID also.
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Arogya Sanjeevani’s policy inclusion
The main inclusions of Arogya Sanjeevani’s health insurance policy are as follows;
- Pre-hospitalisation expenses: The policy covers pre- hospitalisation expenses for a fixed period of 30 days before the hospitalisation.
- Hospitalisation expenses: Under Arogya Sanjeevani health insurance, the policyholder can claim the hospitalisation of 24 hours or more. It covers consultation fees, medicines, nursing expenses, room rent, bed charges, hospital stay charges, etc. Hospitalisation expenses can be covered up to 2% of the sum insured to the maximum of RS—5000 per day hospitalisation charge.
- Post-hospitalization expenses: The policy covers a fixed period of 60 days from the hospital’s discharge date.
- Daycare treatment: Daycare treatment is referred to as the treatment done under local or general anaesthesia on a day. It does not need hospitalisation. The Arogya Sanjeevani health insurance policy covers all daycare treatment expenses up to 50% of the sum insured.
- AYUSH treatment: The policy covers all the inpatient treatment expenses done in Ayurveda, Homeopathy, Unani, and Naturopathy up to a specific amount of the sum insured.
- Emergency care unit expenses: The policy covers ICU and ICCU expenses up to 5% of the sum insured, subject to a maximum of 10,000 per day.
- Minor surgery expenses: The plan covers the costs for minor surgeries like cataracts, small dental procedures, and other minor surgeries up to 25% of the sum insured, subject to a limit of RS—40,000 per day.
- Ambulance cover: The policy covers ambulance expenses up to 2000 per hospitalisation.
- Modern treatment: New age treatments like Bronchial Thermoplasty, Intravitreal injections, Robotic surgeries, Intraoperative Neuromonitoring (IONM), Stem Cell Therapy and many more are covered under the Arogya Sanjeevani health insurance policy up to the limit of 50% sum insured.
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Exclusions of Arogya Sanjeevani policy
Arogya Sajeevani’s exclusions are listed below;
- Any disease that occurred during the first 30 days of the commencement of the policy
- It does not cover any diagnostic investigation tests.
- It does not cover any enforced bed rest in the absence of treatment.
- It does not cover rehabilitation expenses.
- It does not cover any expense arising from obesity treatment or weight management therapies.
- It does not cover the expenses incurred from gender change surgeries.
- It does not cover any plastic or cosmetic surgeries that are not required due to an accident, burn, or injury.
- It does not cover maternity-related expenses.
- It does not cover the OPD treatment taken by the policyholder.
- The Arogya Sanjeevani health insurance policy does not cover expenses for the treatment arising from the addiction to a drug or alcohol.
- It does not cover the treatment of infertility.
- It does not cover the treatment taken outside India.
Benefits of Arogya Sanjeevani policy
Arogya Sanjeevani policy has been launched with a vision to simplify health insurance in India. It is comprehensive health insurance offering basic and standard medical insurance with the same coverage and lower premium. Some of the key advantages of Arogya Sanjeevani policy are as follows;
- It offers the most affordable health policy in India. The premium prices are less expensive than other health insurance policies.
- It offers a lower co-payment option of only 5% of the total claim amount. That means you will only have to pay 5% of the entire claim amount at the time of settlement.
- It offers a cumulative reward as no claim bonus of 5% at every claim-free year.
- It comes with lifetime renewability. That means you can renew your policy for as long as you live.
- Arogya Sanjeevani policy is a boon if you purchase health insurance for the first time because you have a wide range of coverage at the minimum possible premium cost.
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Eligibility criteria
Arogya Sanjeevani policy can be purchased from 18 years to 65 years. If you want to buy an Arogya Sanjeevani policy for your family, you can choose a family floater plan. You can add your spouse, children, parents, and in-laws as a beneficiary of the single-family floater plan. If your child is more than 18 years, you cannot add them to the family floater plan; you need to buy an individual Arogya Sanjeevani plan.
Cancellation and refund policy of Arogya Sanjeevani health insurance
The policy buyer of the Arogya Sanjeevani policy has a 15-day free look-up period. It means the policyholder can cancel their policy within the first 15 days without any cancellation fee. The paid premium will be refunded to the policyholder. Any expenses incurred from the insurance company will be deducted from the refundable amount.
Please note that the free look-up period is not applicable during policy renewal.
The policyholder can also cancel their Arogya Sanjeevani policy after the free look-up period. But they will be required to give 15 days prior written notice to their insurance provider. The premium for the remaining period of the policy will be refunded to them according to the rates.
In the end, if you are planning to ensure the health of yourself and your health, Arogya Sanjeevani’s health insurance policy is the best option. You can purchase it online. The IRDAI has permitted insurance companies to issue the Arogya Sanjeevani policy online to the policyholder. But it is mandatory to have a document in physical form.
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